Cognitive behavioral therapy (CBT) delivered by respiratory therapists is cost-effective and reduces anxiety symptoms in COPD patients, according to research published in ERJ Open Research.
Anxiety often occurs alongside COPD and can mean that patients do less physical activity, leading to loss of fitness, isolation, and deteriorating health overall. The new study found that brief CBT sessions with respiratory therapists reduced feelings of anxiety for patients with COPD and resulted in less frequent use of emergency and hospital services.
“One of the main symptoms of COPD is breathlessness. This is very frightening and often leads to feelings of anxiety. Feeling anxious has a negative impact on patients’ quality of life and leads to more frequent use of healthcare resources,” said lead researcher Karen Heslop-Marshall of Newcastle-upon-Tyne NHS Foundation Trust and Newcastle University, UK. “We wanted to test whether one-to-one CBT sessions delivered by respiratory nurses could reduce symptoms of anxiety and whether this could be a cost-effective intervention.”
A total of 236 patients with a diagnosis of mild to very severe COPD took part in the trial and were screened for anxiety using the HADS-Anxiety Subscale. HADS is a questionnaire that asks patients about their feelings of anxiety and depression over the past week. Scores of between eight and ten are considered to show mild symptoms, 11-14 indicate moderate symptoms, and scores of more than 15 indicate severe symptoms.
All the patients entered into the study scored eight or higher on the HADS scale. In total, 59% of those screened for entry into the study had raised HADS scores, suggesting anxiety is very common in COPD.
Over a three-month period, patients were either given leaflets on anxiety management or given leaflets as well as CBT. The CBT sessions coached patients on how to develop coping strategies to deal with the anxiety caused by breathlessness, to help to improve physical activity levels.
All patients also received standard medical care, including lung function testing, a medical review and appropriate drug treatments. If they were eligible, they also received pulmonary rehabilitation, which is a supervised exercise program designed for COPD patients.
After three months, patients completed the HADS-Anxiety questionnaire again to assess how the different treatment methods affected their levels of anxiety.
The researchers found that CBT was more effective in reducing anxiety symptoms in COPD patients compared to leaflets alone; on average, the HADS-Anxiety scale scores of CBT patients improved by 3.4 points, while patients in the leaflet group improved by just 1.9 points.
After checking the hospital attendance records of patients in the study, the researchers found that for each patient who attended CBT, there was an average savings of $1,395.98 (£1,089) for hospital admissions and $80.76 (£63) for emergency room attendances.
The data also showed no link between a patients’ lung function (FEV1) and their anxiety score. The researchers say this suggests that even patients with mild COPD can feel extremely anxious, and so would benefit from this intervention.
“We found that one-to-one CBT sessions delivered by respiratory [therapists] could reduce symptoms of anxiety and that this could be a cost-effective intervention,” Heslop-Marshall said. “Although the CBT intervention initially resulted in added costs, as respiratory [therapists] required training in CBT skills, this was balanced by the savings made thanks to less frequent need of hospital and [emergency] services.”
“Reducing the levels of anxiety patients experience has a significant impact on their quality of life as well as their ability to keep physically active and may improve survival in the long-term. Our research shows that front-line respiratory staff can deliver this intervention efficiently and effectively.”